Journal of Otolaryngology - Head & Neck Surgery最新文献

ImportanceBRAF V600E mutations are frequently associated with aggressive papillary thyroid carcinomas (PTCs), yet tumors with low allele frequency (AF) are often considered to be indolent. However, exceptions exist, suggesting additional factors may influence tumor behavior. Gene expression alterations (GEA) may help identify tumors with more aggressive molecular phenotypes.ObjectiveTo evaluate whether aggressive clinicopathologic features are associated with GEA positivity in low AF BRAF V600E-mutated PTCs.DesignRetrospective cohort study.SettingTwo McGill University Academic Hospitals, 2019 to 2024.ParticipantsPatients with PTC harboring BRAF V600E (AF ≤ 25%) who underwent preoperative testing.Intervention or ExposureLow AF BRAF V600E mutation (≤25%) characterized using ThyroSeq v3 genomic classifier.Main Outcome MeasuresThe primary outcome was GEA status. Tumor aggressiveness (defined by extrathyroidal extension, lymph node metastasis, lymphovascular invasion, high-risk histology, or aggressive variants), Bethesda classification, and AF were evaluated as predictors of GEA using logistic regression. Stratified analysis was performed based on AF (≤10% vs. >10%).ResultsAmong 49 patients identified (mean age 49 ± 14 years; 86% female; mean AF 11% ± 8%), 73% (36/49) had aggressive features and 61% (30/49) had GEA-positive tumors. Among GEA-positive tumors, 80% (24/30) were classified as aggressive and had a significantly-higher median AF (16.5%) than GEA-negative tumors (P = .0003). Stratified analysis showed that Bethesda VI nodules significantly predicted GEA positivity in tumors with AF > 10% (P = .03).ConclusionIn low AF BRAF V600E-mutated PTCs, GEA positivity is associated with high-risk cytology, higher AF, and aggressive tumor features.RelevanceGEA may be a useful molecular marker of aggressive tumor biology in low AF PTCs and holds potential as a complementary tool for preoperative risk stratification.

ImportanceThe role of artificial intelligence (AI) within medicine has increased exponentially over the last decade. However, adoption across medical specialties remains variable, influenced by institutional support, availability of tools, and concerns about accuracy, privacy, and legal liability. Addressing these barriers is necessary to achieving the full clinical capacity of AI.ObjectivesThis study aimed to explore current AI usage patterns among pediatric otolaryngologists and highlight perceived benefits and barriers to adoption.DesignCross-sectional survey design.SettingAll aspects of the present study were conducted remotely, with the survey link being distributed within a private group chat.ParticipantsParticipants were recruited via an international pediatric otolaryngology WhatsApp group chat. Admission is through invitation only.Intervention or ExposuresThe survey sought to characterize a variety of themes regarding AI, including utilization patterns, attitudes, motivational factors and barriers to adoption, and extent of institutional support.Main Outcome MeasuresResponses were evaluated using chi-squared tests and descriptive statistics.ResultsSurvey responses were analyzed from 50 individuals, reflecting a response rate of 15.2%. More than half of survey respondents (60.9%, n = 28/46) use AI in practice, relying on tools like ChatGPT, iScribe, and Gemini to improve workplace efficiency (71.4%, n = 20/28) and address administrative burdens (64.2%, n = 18/28). Despite current adoption of AI, participants identified a lack of institutional guidelines (66.7%, n = 30/45) and support (54.3%, n = 25/47) as major barriers to widespread integration across the subspecialty. No statistically-significant association was found between age and likelihood of AI adoption (P = .095) nor was between geographic region and likelihood of AI adoption (P = .505).ConclusionsPediatric otolaryngologists are interested in and enthusiastic about AI tools. This study highlights prominent institutional and educational gaps, limiting widespread integration.RelevanceThe findings guide future efforts to support AI adoption in pediatric otolaryngology through tailored training, policy, and institutional support.

ImportanceDizziness/vertigo is a common symptom that can lead to falls and reduced confidence in daily activities. It can result from vestibular, non-vestibular, or unidentified etiologies. Effective treatments with minimal side effects are essential to improving patient outcomes.ObjectiveTo compare the efficacy and safety of Ginkgo biloba extract EGb 761^® with Betahistine in patients with dizziness/vertigo of unclear etiology.Study DesignRandomized, double-blind, controlled trial conducted from October 2022 to August 2023.SettingEar, Nose, and Throat Outpatient Department at Burapha Hospital.ParticipantsEighty-six individuals aged ≥20 with dizziness/vertigo lasting >1 month without a specific etiology.InterventionPatients were randomized to EGb 761^® (120 mg/day) or Betahistine (36 mg/day) with matched placebos for 12 weeks, assessed at weeks 2, 6, and 12.Main Outcome MeasuresPrimary outcome: change in dizziness severity as assessed by the 11-Point Box Scale and Dizziness Handicap Inventory (DHI) scores. Secondary outcomes: safety.ResultsRepeated-measures ANOVA showed significant improvement over time in both groups (P < .001), with no group × time interaction, indicating comparable efficacy. For DHI, Betahistine showed a transient advantage at week 2 (P < .01, Cohen's d = 0.96), but no significant difference between treatments was observed at week 12. Both treatments were well tolerated, with only mild gastrointestinal side effects.ConclusionEGb 761^® and Betahistine demonstrated comparable efficacy and good safety in treating dizziness or vertigo of unclear etiology. Clinical improvement was most evident within the first 2 weeks of therapy.RelevanceEGb 761^® is a safe and effective alternative to Betahistine with comparable efficacy and good tolerability.

ImportanceSelective, modified radical, and radical neck dissections are common surgical procedures that can result in significant musculoskeletal issues of the neck and shoulder. Quality-of-life evaluations after neck dissection must assess and quantify these dysfunctions to allow subsequent comparison of outcomes after different treatments.ObjectiveThere is no validated Spanish-language questionnaire designed to evaluate neck and shoulder dysfunction after cervical lymphadenectomy. We therefore sought to translate a version of the Neck Dissection Impairment Index (NDII) into Spanish.Design, Settings, and ParticipantsA three-phased approach was used. Phase 1: The NDII was translated from English to Spanish using a "forward and backward" translational technique following international guidelines. Phase 2: The questionnaire was administered to six patients from our head and neck surgery clinic who were bilingual and fluent in both English and Spanish. Phase 3: The final version was administered prospectively to 34 patients with prior history of neck dissection (ND). These patients were asked to complete the questionnaire a second time 3 to 6 weeks after their first response. Test-retest reliability was calculated with Spearman's correlation. Internal consistency was elicited using Cronbach's alpha.Main Outcome(s) and Measure(s)NDII score at initial administration and follow-up administration 6 weeks later, demographic data.ResultsNDII was successfully translated and validated into Spanish. Cronbach's alpha revealed high internal consistency at both the first time point 0.95 (mean standardized score: 95 (88.1, 97.5), 95% CI: 0.89, 0.97) and at the second time point 0.90 (mean standardized score: 92.5 (80.6, 100.0), 95% CI: 0.81, 0.95). The Spearman's correlation for test-retest reliability of overall score was strong (rho = 0.772, P < 0.001). The intraclass correlation coefficient of the overall score was moderate (ICC = 0.683, P < 0.001).Conclusions and RelevanceNDII is a recognized, previously validated quality-of-life (QOL) tool for the identification of ND-related dysfunction. This validated Spanish version will allow clinicians to adequately assess the neck and shoulder-related QOL for the Spanish-speaking population who are under-represented in head and neck research.

IntroductionOtolaryngologists were among the physicians with the highest risk of exposure to SARS-CoV-2, and more than half of them reported anxiety and distress during the pandemic. Consequences of this experience on retirement plans among otolaryngologists are unknown. This study aimed to describe the effect of the pandemic on retirement plans among otolaryngologists.MethodsA cross-sectional survey assessed retirement plans of physicians in the Canadian Society of Otolaryngology-Head and Neck Surgery (CSOHNS) between May and June 2023. Participants were recruited through CSOHNS membership lists. Respondents shared demographic information and rated 4 pandemic-related factors and 13 independent factors on a 5-point Likert scale from least important to most important in influencing retirement.ResultsEighty-two members responded, of which 20 (24.4%) were females. All female participants were 65 or younger, whereas 25 (40.3%) males were 65 or older. Half of the participants were in academic practice; 39% reported no change to their anticipated retirement date prior to the pandemic, whereas 25% reported either earlier or later dates. A greater proportion of female otolaryngologists reported earlier dates of retirement than originally planned compared with males (40% vs 19.3%). The factors most commonly rated as "important" were the desire for time with loved ones (mean: 3.82, SD: 1.179), the desire to improve their quality of life (mean: 3.65, SD: 1.344), and increased workload (mean: 3.26, SD: 1.210). Significant differences were observed between genders and age groups (≤55 years vs >55 years) regarding increased workload, desire for improved quality of life, personal and loved ones' health concerns, pandemic-related concerns, psychological/emotional issues, and burnout (P < .05).ConclusionsPandemic-related factors play a limited role in retirement decisions made by otolaryngologists. More females reported earlier retirement dates after the pandemic, which may further exacerbate preexisting gender inequalities in the otolaryngology workforce.

ImportanceIn different types of carcinoma, sex has a strong impact on risk factors, diagnosis, treatment, and outcomes. Previous studies have reported that female patients with head and neck carcinoma (HNC) have better survival.ObjectiveThis study aimed to analyze sex differences in tumor regression and survival, as well as host- and disease-related factors.DesignA retrospective cohort study.SettingTertiary Care, University Hospital.Participants1115 patients registered in the Head and Neck Tumor Registry of the Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck were included.Main Outcome MeasuresSeveral host- and disease-related factors were analyzed to determine possible sex differences.ResultsThis study included 1115 patients with HNC, of whom 78.6% (n = 876) were men and 21.4% (n = 239) were women. There were no differences in tumor regression or incident cases per year in our department between male and female patients with HNC. Statistically significant sex differences were found for tumor site (P < .001), Union for International Cancer Control (UICC) stage (P = .04), treatment modality (P = .027), alcohol consumption (P = .005), and alcohol cessation (P < .001).Conclusions and RelevanceThis study revealed significant sex differences in patients with HNC. Female patients with HNC were characterized by a higher percentage of oral carcinoma, lower UICC tumor stage, single treatment modality, and less alcohol consumption than men.

ObjectiveTo study whether the ability to detect frequency changes or temporal gaps at the early phase postactivation can predict speech perception performance at the late phase postactivation in postlingually deafened cochlear implant (CI) users.MethodPsychophysical tests and event-related potential (ERP) tests were conducted at the third-month postactivation (early phase postactivation, T1) and after 1-year postactivation (late phase postactivation, T2) in 27 postlingually deafened CI users. CI hearing thresholds and speech perception performance were measured at T1 and T2. The frequency change detection threshold (FCDT) and gap detection threshold (GDT) were obtained through psychophysical tests. The evoked threshold, amplitude, and latency of auditory change complex response, evoked by frequency change or temporal gap stimuli, were investigated using ERP tests.ResultsCompared with T1, speech perception performance was significantly better at T2, but there was no significant difference in the psychophysical or ERP test results. Speech perception performance at T2 could be predicted by GDT at T1, but not by FCDT or ERP indicators at T1. Receiver-operating characteristic curve analysis suggested that the GDT at T1 may be moderately accurate in discriminating between good and poor speech perception groups at T2.ConclusionCompared to early phase postactivation, CI users' ability to detect frequency changes or temporal gaps did not change significantly at the late phase postactivation, but speech perception performance improved significantly. The early GDT can predict later speech perception performance of CI users.Level of EvidenceIII.

ImportanceUnlike other head and neck cancers, head and neck soft tissue sarcoma (HN-STS) is staged similarly to sarcomas in the trunk and extremities. The current American Joint Committee on Cancer (AJCC) staging system has limitations that hinder accurate prognosis prediction for HN-STS.ObjectiveWe aimed to develop a novel location-grading-node-metastasis (LGNM) staging system based on the primary tumor location to more accurately stratify prognosis for HN-STS.DesignA retrospective case series from 1990 to 2021.Setting/ParticipantsThis study included 471 patients diagnosed with HN-STS at Sun Yat-sen University Cancer Center between 1990 and 2021.Main outcome measuresIn the primary analysis, we obtained the overall survival (OS) rate. Secondary measures included area under the receiver operating characteristic curve, Harrell's C, Somers' D, Gönen and Heller's K, O'Quigley's ρ2k, Royston's R², the Bayesian information criterion for concordance, and variation in patient outcomes.ResultsThe eighth edition of AJCC T classification for tumor size inadequately conveys prognosis information. In contrast, the primary tumor location and local invasion are prognostic factors for HN-STS and categorized into 4 stages: L1 (low risk: scalp, face, supraclavicular, ear), L2 (intermediate risk: neck, paravertebral, pharynx, tonsil, eye, orbit), L3 (high risk: cavity, lip, palate, buccal mucosa, salivary gland, maxilla, mandible), and L4 (any location with local invasion). The new LGNM staging system effectively distributed patients into stages I to IV, with statistically-significant survival differences among these stages. Five-year OS rates were 96.9% for stage I, 78.4% for stage II, 37.1% for stage III, and 7.1% for stage IV (P < .001). Additionally, the LGNM staging system demonstrated superior predictive ability and concordance compared with the seventh and eighth editions of AJCC staging systems.Conclusions/RelevanceThe LGNM staging system shows better homogeneity and discriminatory power than the AJCC system, improving risk stratification and prognosis prediction in HN-STS.

Importance: Perineural invasion (PNI) is an established prognostic factor in oral squamous cell carcinoma (OSCC), but the impact of its subcategories on survival is not fully understood. This study quantifies the number and diameter of PNI foci to assess their prognostic relevance in OSCC.

Objective: To evaluate the prognostic significance of PNI subcategories, specifically the number and diameter of PNI foci, as predictors of overall survival (OS) and disease-free survival (DFS) in OSCC patients.

Design: Retrospective cohort study, adhering to STROBE guidelines.

Setting: Single-center study at MacKay Memorial Hospital, Taiwan, including patients diagnosed with OSCC from 2005 to 2018.

Participants: Nine hundred twenty-six patients with biopsy-proven OSCC, excluding those with perioperative mortality or incomplete follow-up.

Exposure: Histological evaluation of PNI, including quantifying the number and diameter of invaded nerves, along with clinicopathological features such as tumor stage and lymphovascular invasion (LVI).

Main outcome measures: OS and DFS, assessed via Cox proportional hazards models, Kaplan-Meier survival analysis, and receiver operating characteristic curve analysis for PNI foci subcategories.

Results: PNI was present in 138 (14.9%) patients and was significantly associated with adverse histologic features, advanced tumor stage, nodal involvement, metastasis, and LVI. Multivariate analysis revealed that both the number of PNI foci greater than 4 and nerve diameters exceeding 0.21 mm were significantly associated with poorer OS and DFS (P < .05). After adjusting for clinical variables, PNI remained an independent predictor of worse OS [hazard ratio (HR): 1.37] and DFS (HR: 1.46).

Conclusions and relevance: PNI is a significant independent prognostic factor in OSCC. Patients with more than 4 PNI foci or nerve involvement greater than 0.21 mm in diameter experienced significantly worse survival outcomes. These findings suggest that detailed assessment of PNI subcategories should be incorporated into OSCC management, guiding treatment decisions and potentially informing the need for adjuvant therapies.

Objective: Surgical training programs have a high prevalence of trainee stress and burnout. Formal mentorship programs (FMP) have been shown to alleviate these factors and improve quality of life (QOL) in short-term follow-up. This study aims to determine the long-term effects of an FMP on the well-being of a single-center cohort of surgical trainees.

Methods: A voluntary FMP was established at a surgical training program comprised 8 resident physicians. To quantitatively measure stress and burnout, the Perceived Stress Survey (PSS) and Maslach Burnout Inventory (MBI) were administered at baseline, 3, 6, 9, 12, 18, and 24 months. The World Health Quality of Life-Bref Questionnaire (WH-QOL) was administered at baseline, 12 and 24 months.

Results: Baseline levels of stress and burnout were high among all residents with an average PSS of 18.5 and MBI of 47.6, 50.6, and 16.5 for the emotional, depersonalization, and personal achievement domains respectively. After FMP implementation, PSS was reduced to 7.9 at 12 months (P = .001). These scores were sustained at 24 months (6.8, P = 1). MBI scores improved in emotional exhaustion (14.9, P < .0001), depersonalization (20.1, P < .0001), and personal achievement (40.1, P < .0001) at 12 months. All these benefits were sustained at 24 months. Baseline overall WH-QOL scores reflected low QOL (71.9). These significantly improved at 12 months (37.5, P = .002) with further improvement by 24 months (17.2, P = .03).

Conclusion: Long-term follow-up of a previously successful academic surgical FMP showed lasting improvements in stress, burnout, and overall QOL, despite new life challenges.